Peripherally Inserted Central Catheters And Midline Catheters

What are peripherally inserted central and midline catheters?

A catheter is a small tube used to give treatments and to take blood. The catheter is guided into place through a peripheral vein in your upper arm. Peripheral veins lead from your arms and legs to your heart. A peripherally inserted central catheter (PICC) is guided into a vein near the heart. A midline catheter is guided into a vein below the armpit.

Why might I need a PICC or midline catheter?

  • You need long-term IV therapy: A catheter has one or more lumens (openings). Caregivers can give you medicine, take blood, or do other tests through these openings. PICC and midline catheters can stay in place longer than some other types of IV catheters. Caregivers can give you medicine such as IV antibiotics or chemotherapy for several weeks. You can also receive TPN (liquid food) through a PICC..

  • Your veins need to be protected: Caregivers may have a hard time placing an IV if your veins are small or damaged. You may also need medicine that could harm your skin or small veins. Your skin and veins are protected when the medicine goes through the catheter instead.

  • You often need blood transfusions or blood drawn for tests: You can receive blood through the catheter. Caregivers can also take blood samples. You will not have a needle put into a vein each time. Caregivers will use the catheter instead.

How can I prevent catheter-associated infections?

The area around your catheter may get infected, or you may get an infection in your bloodstream. A catheter-associated infection is caused by bacteria (germs) getting into your bloodstream through your catheter. Infections from catheters can lead to severe illness. The following are ways you can help prevent an infection:

  • Wash your hands: Use soap or an alcohol-based hand rub to clean your hands. Clean your hands before and after you touch the catheter or the catheter site. Ask caregivers for information on how to wash your hands. Remind anyone who cares for your catheter to wash their hands.

  • Wear medical gloves: Wear clean medical gloves when you touch your catheter or change bandages.

  • Limit contact: Do not touch or handle your catheter unless you need to care for it. Do not pull, push on, or move the catheter when you clean your skin or change the bandage.

  • Clean your skin: Clean the skin around your catheter every day and just before you change your bandage. Ask your caregiver what to use to clean your skin.

  • Check for infection: Check your skin every day for signs of infection, such as pain, redness, swelling, and oozing. Contact your caregiver if you see these signs.

  • Cover the area: Keep a sterile bandage over the catheter site. Change the bandage as directed or when it is loose, wet, dirty, or falls off. Change your bandage in a place away from open windows, heating ducts, and fans. Be sure it is well-lit, clean, and free of dust. Clean the skin under the bandage with the solution your caregiver suggests. Let the area dry before you put on the new bandage.

  • Keep the area dry: Do not let your catheter or catheter site get wet. Wrap your arm with plastic and seal with medical tape before you bathe. Ask if you should take showers instead of baths.

How do I care for my PICC or midline catheter?

Your caregiver may want you to do the following to care for your catheter and to reduce your risk of infection or complications:

  • Clean the catheter parts: Clean the caps, hubs, and injection ports before you attach and after you remove tubing from your catheter. Open the package that contains the new alcohol pad. Put on new medical gloves. Use a new alcohol pad for each part you clean. Throw away used alcohol pads.

  • Flush your catheter: Your caregiver may give you syringes filled with saline (salt water) or heparin (a blood thinner) to flush your catheter.

    • Attach the syringe that contains the flushing solution to the end of the catheter tubing. Slowly push the fluid out of the syringe and into the catheter. Throw away the syringe. Clean the end of the catheter or cap with a new alcohol pad.

    • Do not force the fluid. Force could damage the catheter, or release a blood clot from the end of the catheter. Straighten any kinks in the tubing. Contact your caregiver if it is still hard to push fluid into the catheter.

  • Change the caps and medicine tubing: You may need to use extra tubing to get medicine. Ask your caregiver how often to change the caps and the medicine tubing.

  • Clamp the catheter: You may need to clamp your catheter at certain times, such as when the tubing is being changed. The catheter is clamped to help prevent air from getting in.

  • Loop extra tubing: Loosely loop the tubing together. Secure it to your arm with medical tape. This will help prevent the PICC or midline catheter from being pulled out by accident.

What are the risks of having a PICC or midline catheter?

  • One or more attempts may be needed to place the catheter. The vein where your catheter is placed may become irritated, and your skin may get red, painful, and blister. When the catheter is put in, your vein may tear, or the catheter may injure a nerve. Your catheter may get blocked, and caregivers may need to remove or replace it.

  • The catheter may break, bend, or move out of place. The IV medicine may leak outside your vein and cause pain, swelling, or blisters. You can have bleeding, an allergy to heparin, or heparin-induced thrombocytopenia (HIT). HIT is a low number of blood platelets, which increases the risk of bleeding. You may get a blood clot in your arm. This can cause pain and swelling, and can stop blood from flowing where it needs to go in your body. The blood clot may break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.

  • If you do not have a catheter placed, you may need to get multiple needle sticks. It may be hard for caregivers to give you the treatment that you need. Your condition may get worse, or you may die. Contact your caregiver if you are worried or have questions about having a catheter placed.

How do I care for myself at home?

The area where the catheter was inserted may feel sore. A warm compress can help to decrease pain and swelling. Wet a small towel with warm water. Wring out the extra water. Wrap the cloth in plastic, and put it on the area. Use the compress 4 times a day, for 10 minutes each time. Prop your arm on pillows when you are sitting or lying down to decrease swelling.

When should I contact my caregiver?

Contact your caregiver if:

  • You have a fever.

  • The catheter site is red, warm, painful, or oozing fluid.

  • You see blood on your bandage and the amount is increasing.

  • The veins in your neck or chest bulge.

  • You cannot flush your catheter, or you feel pain when you flush your catheter.

  • You see that the catheter is getting shorter, or it falls out. Put pressure over the catheter site with a clean towel.

  • You see a hole or a crack in your catheter. Clamp the catheter above the damage before you contact your caregiver.

  • You have questions about how to care for your catheter.

  • You run out of supplies to care for your skin or catheter.

When should I seek immediate care?

Seek care immediately if:

  • You feel pain in your arm, neck, shoulder, or chest on the side of the body where your catheter is inserted.

  • The catheter site turns cold, changes color, or you cannot feel it.

  • You have chest pain or trouble breathing that is getting worse over time.

  • You see blisters on the skin near your catheter site.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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